CHEST PAIN IN PEDIATRICS - 07/09/11
Résumé |
Chest pain is an alarming complaint in children, leading an often frightened and concerned family to a pediatrician or emergency room and commonly to a subsequent referral to a pediatric cardiologist. Because of the well-known association of chest pain with significant cardiovascular disease and sudden death in adult patients, medical personnel commonly share heightened concerns over pediatric patients presenting with chest pain. Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in origin. Organ systems responsible for causing chest pain in children include* :
• | Idiopathic (12%–85%) |
• | Musculoskeletal (15%–31%) |
• | Pulmonary (12%–21%) |
• | Other (4%–21%) |
• | Psychiatric (5%–17%) |
• | Gastrointestinal (4%–7%) |
• | Cardiac (4%–6%) |
Furthermore, chest pain in the pediatric population is rarely associated with life-threatening disease; however, when present, prompt recognition, diagnostic evaluation, and intervention are necessary to prevent an adverse outcome. This article presents a comprehensive list of differential diagnostic possibilities of chest pain in pediatric patients, discusses the common causes in further detail, and outlines a rational diagnostic evaluation and treatment plan.
Chest pain, a common complaint of pediatric patients, is often idiopathic in etiology and commonly chronic in nature. In one study,67 chest pain accounted for 6 in 1000 visits to an urban pediatric emergency room. In addition, chest pain is the second most common reason for referral to pediatric cardiologists.7, 23, 78 Chest pain is found equally in male and female patients, with an average age of presentation of 13 years.67 Chest pain in the pediatric population is most commonly idiopathic in etiology, representing 23% to 45% of all cases.17, 48, 63, 67 Children fewer than 12 years of age are more likely to have a cardiorespiratory cause of their chest pain compared with children more than 12 years of age, who are more likely to have a psychogenic cause.63, 67 In addition, patients diagnosed with psychogenic chest pain or costochondritis are more likely to be female.4, 9, 63 Chest pain is a chronic condition in the pediatric population, with persistent symptoms in 45% to 69% of patients17, 57, 63 and 19% of patients having symptoms lasting for more than 3 years.57 The corollary, of course, is that in 81% of patients with persistent symptoms, the chest pain resolves with time. Clinically reassuring is that none of the patients followed over 3 years developed any severe disease process.57 Because of the chronic nature and often unconfirmed cause of chest pain, pediatricians must develop a trusting, working relationship with these children and their families and be prepared to work jointly over time in diagnosing and treating patients with this very common and predominantly benign complaint.
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| Address reprint requests to Keith C. Kocis, MD, MS, University of Southern California School of Medicine, Childrens Hospital Los Angeles, MS 66, 4650 Sunset Boulevard, Los Angeles, CA 90027 |
Vol 46 - N° 2
P. 189-203 - avril 1999 Retour au numéro
Article précédent
- EVALUATION OF THE PEDIATRIC PATIENT WITH A CARDIAC MURMUR
- Andrew N. Pelech
- SYNCOPE IN THE PEDIATRIC PATIENT : The Cardiologist's Perspective
- David A. Lewis, Anwer Dhala
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